Tuberculosis, un diagnóstico más a tener en cuenta ante una masa pancreática / Tuberculosis, one more consideration in the differential diagnosis of a pancreatic mass

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Hartmann's procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery.

INTRODUCTION AND OBJECTIVES: Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy). MATERIAL AND METHODS: A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index. RESULTS: Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33). CONCLUSIONS: Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk.

Hartmann's procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery

Introducción y objetivos. Un número elevado de cirujanos continúa empleando como técnica de elección la intervención de Hartmann en la obstrucción intestinal aguda maligna de colon distal al ángulo esplénico, sin peritonitis fecaloidea, a pesar de las críticas desde las unidades coloproctológicas de prestigio. Nos proponemos revisar nuestros resultados con esta técnica y compararlos con los de otras series con cirugía en un tiempo (resección y anastomosis primaria y colectomía subtotal). Material y métodos. Estudio retrospectivo y descriptivo sobre historias clínicas. Las variables estudiadas son: estancia media, morbimortalidad e índice de reconstrucción. Resultados. Cuarenta y cuatro pacientes (24 hombres y 20 mujeres) forman parte del estudio, con edades comprendidas entre 37 y 87 años (media 67,04). La estancia media hospitalaria fue de 15,59 días (rango: 8-39). En los 10 pacientes reconstruidos la estancia fue 12,8 (rango: 10-17). La estancia acumulada, por tanto, fue 28,39 días. La estancia media de las series consultadas con cirugía en un tiempo es de 13,9 días. El porcentaje de complicaciones en la operación de Hartmann fue del 43,18% (19/44) y en la reconstrucción siguiente del tránsito fue del 40% (4/10). La morbilidad media de las series consultadas en un tiempo es del 22,53% La mortalidad global de nuestra serie fue del 0%. La mortalidad media de las 16 series consultadas es ligeramente superior al 4%, aunque en 3 de ellas fue también del 0%. El porcentaje de reconstrucción fue del 22,72% (10 casos). La media de edad en los pacientes no reconstruidos fue 71,42 años (rango: 46-87), frente a 52,6 (rango: 37-67) en el grupo de los reconstruidos (p < 0,001). El porcentaje de reconstrucción según el estadio tumoral fue: estadio B el 36,84%, C el 23,07% y D el 0% (p < 0,001). El tiempo medio de espera antes de la reconstrucción fue 15,73 meses (rango: 8-33). Conclusiones. El análisis comparativo de nuestros resultados con los propios de las series de cirugía en un tiempo nos invita a aconsejar esta última como la más idónea, aunque siempre bajo dos condiciones: un dominio de su técnica, para minimizar complicaciones, y una rígida selección de los pacientes, procurando la técnica de Hartmann para los más deteriorados

Introduction and objectives. Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy). Material and methods. A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index. Results. Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33). Conclusions. Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk